NPIMap

Organization Active NPI

Sullins Eye Care P.C.

  • Optometrist
  • Madisonville, TN
National Provider Identifier
1720142771
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD0000001689 Issued in TN
Legal business name
SULLINS EYE CARE P.C.
Practice address
620 Englewood Rd
Madisonville, TN 37354-1218
Phone
(423) 442-2806
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christa H. Sullins, ODNPI 1861498917
Title
Optometrist
Phone
(423) 442-2806

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD0000001689 TN Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD0000001899 TN
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OD0000001722 TN

Addresses

Primary practice location

620 Englewood Rd
Madisonville, TN 37354-1218

Mailing address

PO Box 247
Madisonville, TN 37354-0247
Phone (423) 442-2806

Other identifiers 1

IdentifierTypeStateIssuer
3590906OtherTNMEDICARE

Other names 1

  • Sullins Eye Care P.C. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070823000084 TN Part B Supplier - Clinic/Group Practice 9436241304 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, TN; Madisonville, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

620 Englewood Rd
Madisonville, TN 37354
Phone (423) 442-2806

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1720142771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "373540247",
            "telephone_number": "423-442-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 ENGLEWOOD RD",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "373541218",
            "telephone_number": "423-442-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLINS EYE CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "SULLINS",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "423-442-2806",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD0000001689",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD0000001899",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD0000001722",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "3590906",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullins Eye Care P.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madisonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.